Department of Pediatrics, MacKay Children's Hospital and MacKay Memorial Hospital, Taipei, Taiwan; Department of Pediatrics, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei, Taiwan.
Department of Pediatrics, MacKay Children's Hospital and MacKay Memorial Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medicine College, New Taipei, Taiwan; MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan.
J Microbiol Immunol Infect. 2022 Aug;55(4):728-739. doi: 10.1016/j.jmii.2022.01.007. Epub 2022 Mar 3.
This study aimed to describe the etiology, clinical features, hospital course, and outcomes of hospitalized children with skin and soft tissue infections (SSTIs) and to test if clinical and laboratory variables at admission could differentiate between community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) and community-acquired methicillin-sensitive S. aureus (CA-MSSA).
We reviewed the clinical, laboratory, treatment, and outcome data for children hospitalized with SSTIs, aged 0-18 years at MacKay Children's Hospital between 2010 and 2019. Multivariable logistic regression was used to identify independent predictors of CA-MRSA and CA-MSSA SSTIs.
A total of 1631 patients were enrolled. Erysipelas/cellulitis (73.8%) was the most common pediatric SSTI type, followed by acute lymphadenitis (13.6%) and abscess/furuncle/carbuncle (8.6%). Among the 639 culture-positive isolates (purulent SSTIs), 142 (22.2%) were CA-MSSA and 363 (56.8%) were CA-MRSA. The age group 0-1 month (OR, 6.52; 95% CI 1.09-38.92; P = 0.04) and local lymph node reaction (OR, 2.47; 95% CI 1.004-6.08; P = 0.049) were independent factors for differentiating children with CA-MSSA from those with CA-MRSA SSTIs. MRSA isolates in our cohort were highly susceptible to glycopeptides (100%), linezolid (100%), daptomycin (100%), and sulfamethoxazole/trimethoprim (98.6%) but were significantly less susceptible to clindamycin compared with MSSA (34.2% vs. 78.2%, P < 0.001).
S. aureus is the leading pathogen of culture-proven SSTIs in hospitalized children with MRSA accounting for more than half. Determining the optimal empirical antibiotics in CA-SSTIs may rely on the patient's age, disease severity, and local epidemiologic data.
本研究旨在描述住院儿童皮肤和软组织感染（SSTIs）的病因、临床特征、住院过程和结局，并检验入院时的临床和实验室变量是否能区分社区获得性耐甲氧西林金黄色葡萄球菌（CA-MRSA）和社区获得性甲氧西林敏感金黄色葡萄球菌（CA-MSSA）。
我们回顾了 2010 年至 2019 年期间在麦凯儿童医院住院的年龄在 0-18 岁的儿童 SSTIs 患者的临床、实验室、治疗和结局数据。采用多变量逻辑回归分析确定 CA-MRSA 和 CA-MSSA SSTIs 的独立预测因素。
共纳入 1631 例患者。丹毒/蜂窝织炎（73.8%）是最常见的儿科 SSTI 类型，其次是急性淋巴结炎（13.6%）和脓肿/痈/疖（8.6%）。在 639 例培养阳性分离株（脓性 SSTIs）中，142 例（22.2%）为 CA-MSSA，363 例（56.8%）为 CA-MRSA。0-1 个月龄组（OR，6.52；95%CI 1.09-38.92；P=0.04）和局部淋巴结反应（OR，2.47；95%CI 1.004-6.08；P=0.049）是区分 CA-MSSA 和 CA-MRSA SSTIs 患儿的独立因素。本研究中 MRSA 分离株对糖肽类（100%）、利奈唑胺（100%）、达托霉素（100%）和磺胺甲噁唑/甲氧苄啶（98.6%）高度敏感，但与 MSSA 相比，克林霉素的敏感性显著降低（34.2%比 78.2%，P<0.001）。
金黄色葡萄球菌是住院儿童中经培养证实的 SSTIs 的主要病原体，其中 MRSA 占一半以上。确定 CA-SSTIs 中最佳经验性抗生素可能取决于患者的年龄、疾病严重程度和当地的流行病学数据。
